The fault of others: exiles, scapegoats and the human face of disease

Health education poster, United Kingdom, 1987-1992

Where do people think disease comes from?

How diseases are interpreted by the people they threaten changes over time and within cultures. But there are common factors. One is a tendency to view disease as coming from somewhere else - from ‘other people’. Disease might even be given a human face through association with a particular individual. When confronted by new and frightening illnesses, people can create scapegoats as a totally misguided means of coping with fear, focusing blame and bolstering prejudices.

Stereotypes, blame and the spread of disease

Marginal groups, minorities and the poor have been common targets. Jews were widely blamed for the Black Death and immigrant Irish workers held responsible for cholera epidemics in the 1830s. Blame can be international. The appearance of syphilis in Renaissance Europe became a classic example of passing the blame. Syphilis was christened the ‘French disease’ by the British, but the French held the Italians responsible. They returned the compliment. The Dutch blamed the Spanish, while the Russians blamed the Poles. In Japan the Portuguese were at fault, whereas the Turks simply called it the Christian disease. And when in 1769 Captain Cook observed the disease on Tahiti, it was known to all islanders as the British disease!

Unethical research in the USA in the 1900s

Such stereotyping can cause real harm. For example, early last century the incidence of syphilis in the United States was relatively high in poor black communities. Some American researchers blamed this on what they perceived as innate racial weaknesses. It was a ‘black disease’, a misguided prejudice that inspired the infamous Tuskegee study, a racist and unethical research project in which 400 black men carrying the disease were kept under observation but left untreated for decades.

Typhoid Mary

Leprosy, like syphilis, acts slowly and disfigures terribly. Sufferers were known as ‘lepers’ and were traditionally forced to live isolated lives in leper colonies. They were shunned, hated and feared, and the word ‘leper’ still has connotations way beyond its strict medical meaning. Indeed, ‘Why should I be banished like a leper?’ was what Mary Mallon asked in 1909. Better known as Typhoid Mary, she was a carrier, but not a sufferer, of that disease. But she became the personification of disease in America and her foreign origins a subject of public debate, providing propaganda for those calling for the vaccination of all new immigrants. The journal Scientific American invoked both ancient prejudices and plague myths when commenting that Mary ‘had competed with the Wandering Jew in scattering destruction in her path’ - the Wandering Jew being a legendary figure from Christian folklore, one of whose incarnations was as a spreader of disease.

'Patient Zero' and the AIDS epidemic

This need to give disease a face persists. In the early 1980s, the beginnings of the AIDSepidemic in America saw the demonisation of minority groups and, in ‘Patient Zero’, an individual. From the beginning, the disease was publicly linked to the gay community. Members of a community that was beginning to enjoy a more confident public profile were suddenly being struck down. This played to some people’s inherent prejudices. They saw AIDS as a kind of retribution. It became labelled a ‘gay plague’, at the centre of which was Patient Zero, dubbed ‘The Monster who gave us AIDS!’ by one US tabloid.

Disease and the poor

In time, increased understanding of AIDS helped change these early perceptions, but from a Western viewpoint the associations have simply shifted to other groups. Now, as is so often the case, it is perceived more as a disease of the poor and of the developing world, where access to life-saving drugs and health education can be very limited.